Multidisciplinary Management of Non-Healing Umbilical Ulcer in an Infant: A Case Report

This case report outlines the intricate clinical management of a 5-month-old infant with recurrent bacterial infections and a non-healing umbilical ulcer following the surgical excision of a urachal remnant. The infant’s medical history was significant for delayed umbilical cord detachment and multiple surgical site infections. The initial surgical approach included the excision of the residual urachus, wound debridement, and abdominal wall reinforcement using a collagen matrix combined with local flap closure. Despite an apparently uneventful postoperative course, the wound experienced dehiscence and failed to heal. As part of the diagnostic workup, genetic testing was conducted, revealing an autosomal dominant mutation in the RAC2 gene, which impairs neutrophil function. Given the urgent need for wound closure prior to hematopoietic stem cell transplantation (HSCT), further debridement and sessions of negative pressure therapy were performed, alongside attempted repair with acellular dermal regeneration matrices, which ultimately proved to be ineffective. Ultimately, HSCT was undertaken despite the infectious associated risks, resulting in spontaneous wound healing without requiring further surgical interventions. This case highlights the challenges of coordinating medical, surgical, and hematological treatments in such complex cases, necessitating effective communication and collaboration among multidisciplinary teams to optimize patient outcomes.